The 1930s Scientist Who Popularized a Terrifying Brain Surgery

Medical science advanced at an astonishing pace in the twentieth century. On the whole, that is wonderful. That is a great boon for humanity. But there can be a downside to new medical science, as when it is wielded by a charismatic demagogue who cares more about his own reputation than the wellbeing of his patients.

Now, there have always been charlatans who claimed to have cures for dangerous diseases despite having no such thing. Their outrageous conduct meant that patients often died—a good indication that their treatment didn’t work. However, with scientific advances, quacks could offer more than just charms to ward off disease. By the twentieth century medical science had advanced to a point where unscrupulous individuals could cause irreversible damage to patients without actually killing them. And then they could call their procedures “successes.” And people were not vigilant enough, or not sufficiently aware, to say, “No, that is not what success means.”

Which brings us to lobotomies,one of the scariest procedures modern medicine has produced. When I began writing my book, Get Well Soon: History’s Plagues and the Heroes Who Fought Them, I originally intended to focus on plagues induced by disease, not by human stupidity. This one falls squarely into the latter camp, but still, I couldn’t write a book on deadly medical horrors without talking about the terror wreaked by Walter Jackson Freeman II.

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The first leucotomy or lobotomy was performed on a human by the Portuguese neurologist Antônio Egas Moniz in 1935. This operation involved drilling holes into a patient’s skull and then making cuts into the brain’s frontal lobes to sever their connections to the rest of the brain.

He was inspired by a similar surgery that had been performed on a pair of chimpanzees at Yale University. The chimps, named Becky and Lucy, lost their problem-solving abilities after researchers removed the frontal lobes of their brains, according to a 2010 episode of the PBS series American Experience. But scientists also noticed that Becky was no longer frustrated when she was unable to solve problems. She was not bothered in the way a puzzle-solving chimpanzee should be at all.

The takeaway from the chimp experiment should have been, “Well, that was interesting. But let’s not mess around with anyone’s frontal lobes.” But Becky’s response to the procedure stood out. A reduction in anxiety and negative emotion is striking and, at first glance, seems like a very good result.

Dr. Moniz believed that such an operation would make life far better for the insane. And if “better life” just constitutes “being less worried and agitated,” he was correct. There is one problem, though: worrying about stuff serves a purpose. It means you are capable of caring and solving problems. Which means you are qualified to be an empathetic, adult human being.

Dr. Moniz was not considering the disadvantages of a life without worry.

The first lobotomies involved drilling two holes about three centimeters deep directly into a patient’s skull over the frontal lobes. Then alcohol was injected into the frontal lobes in an attempt to disrupt neural pathways. When the ethyl alcohol proved less than entirely effective, Moniz and his team began cutting the lobe with wire, using an instrument called the leucotome. They didn’t actually remove the frontal lobes, they just severed the connections between the frontal lobes and the rest of the brain. That’s a delicate bit of neurosurgery.

Unlike Moniz, Walter Jackson Freeman II, while a physician, was not a surgeon, let alone a neurosurgeon. That did not stop him.

He and his partner James Watts performed the first version of this surgery in the United States in 1936. Their patient was a 63-year-old woman named Alice Hammatt. She suffered from severe depression—perhaps aggravated by the fact that one of her children had died, as had her sister and brother- in-law in a murder-suicide pact.

After the operation Hammatt was free from anxiety. That said, after the operation she was also only able to flip through magazines and draw pictures. She wasn’t able to have a coherent conversation. She ultimately regained her ability to speak, although “her husband and maid did most of the work” around her home, according to Freeman. But she was very happy with the procedure and felt that she spent a lot less time worrying. Freeman thought “the result was spectacular.”

Perhaps the most famous example of a lobotomy gone very wrong was Rosemary Kennedy, the daughter of Rose and Joseph P. Kennedy and one of the sisters of President John F. Kennedy.

Rosemary’s IQ was estimated to be low, likely from brain damage caused by a shortage of oxygen during her birth.

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Rosemary was hardworking, affectionate, and fiercely devoted to her family. She grew older, however, and while her other siblings moved on to their own seemingly more exciting lives, Rosemary became increasingly prone to temper tantrums. Her father, Joseph, was terrified that she’d have premarital sex, possibly get pregnant, and embarrass the family at a time when he was mapping out his sons’ political careers. In 1941, when Rosemary was age 23, he decided a lobotomy might be a cure for her unpredictable behavior, engaging Freeman and Watts to perform it.

After the operation she was unable to walk or talk. Even with years of rehabilitative efforts, she was only ever able to speak a few words. However, at the time the public never learned about what happened to Rosemary or cases like hers. It was in neither the Kennedy family’s nor Freeman and Watts’s interest to let people know about the horrifying effects of her operation.

Results like these weren’t enough to deter Freeman. Remarkably, he came to think that Moniz’s technique was not efficient enough to lobotomize all the people who he believed could benefit from the procedure. He and his partner thought that the drilling was the most bothersome part for patients. They claimed: “Apprehension becomes a little more marked when the holes are drilled, probably because of the actual pressure on the skull and the grinding sound that is as distressing, or more so, than the drilling of a tooth.”

So they developed the transorbital lobotomy, which involved inserting an ice pick into a patient’s skull through the bone known as the orbit at the back of the eye socket. Patients were generally subdued with electroshock therapy beforehand. Then the ice pick was driven through the back of the eye with a hammer. There, it would be moved back and forth in the same motion as an eggbeater, severing connections between the thalamus (which controls the motor systems of the brain, extending to basic functions like movement and consciousness) and frontal lobes (which regulate higher intellect).

The operation itself could be performed in less than ten minutes, and as soon as the bleeding stopped, patients were sent home, generally in a taxi, just as if they had been to the dentist—even though lot of the patients could barely remember who they were when they were being herded into the car.

In 1946 Freeman performed his new transorbital operation on Sallie Ellen Ionesco. She was severely depressed, and had previously tried to commit suicide and to smother one of her children. After the lobotomy she was never violent again. When she was interviewed about it later, she claimed, “[Freeman] was a great man, that’s all I can say … I don’t remember nothing else, and I’m very tired.” Her daughter, however, did say that she wished Freeman “hadn’t gotten quite so out of hand.”

Many of the people who were lobotomized were untroubled by the results. According to John B. Dynes and James L. Poppen in their 1949 American Medical Journal article “Lobotomy for Intractable Pain,” after patients were operated on, “they never admitted they were mentally depressed and at no time did they show grief or shed tears.” However, all of the patients that Dynes and Poppen surveyed who before their lobotomies had been classified as “normal” or in some cases in an “anxiety state” were afterward classified as “retarded” or “euphoric.” In addition to feeling no depression: “They were indifferent to sorrow or grief, and seemed incapable of sensing or appreciating the feelings of others.”

Often Freeman was inclined to see his operations as successful, while those closer to the patients saw them as anything but. Regarding the “success” of the operation on a 24-year-old schizophrenic, Freeman reported: “It apparently requires some imagination, as well as some emotional driving force, to bring about misbehavior at the legally reprehensible level and this the patient is incapable of.” That patient also probably did not have time to misbehave, given his brother’s statement that “he had lost all sense of time, spending four to six hours a day washing his hands but nevertheless going around with dirty clothes.”

The more lobotomies Freeman performed, the more obvious the disadvantages of the operation became. Even Freeman admitted, “Every patient probably loses something by this operation, some spontaneity, some sparkle, some flavor of the personality.”

What is that elusive “sparkle”? Is it a certain panache that accompanies the telling of one’s stories? An almost Fitzgeraldian gleam in someone’s eye as they exclaim, “To the wine cellar, Maurice! We’re going to fill this bathtub with champagne!”